Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs
Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs
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DOI：
10.1377/hlthaff.2013.0747
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发表时间：
2014-02-01
期刊：
影响因子：
9.7
通讯作者：
Bond, Amelia M.
中科院分区：
文献类型：
--
作者：
White, Chapin;Reschovsky, James D.;Bond, Amelia M.
私人保险公司为各医院的住院护理支付的价格差异很大。以往的研究表明，某些医院利用市场影响力来获得较高的付费率，但很少深入研究医院特征与定价能力之间的关系。这项研究使用私人保险索赔数据来确定住院价格明显高于或低于市场中位数的医院。与其他医院相比，高价医院往往规模更大；是大型教学医院；属于市场份额较大的系统；并提供专业服务，例如心脏移植和一级创伤护理。高价医院还从非患者来源获得大量收入，例如州医疗补助不成比例地分享医院资金，并且它们享有健康的总财务利润。高价医院的质量指标好坏参半：在《美国新闻与世界报道》排名中，高价医院的表现比低价医院好得多，这些排名主要基于声誉，而在客观质量指标（例如术后死亡率）上通常得分较低。因此，如果保险公司试图引导患者远离高价医院，他们可能会面临阻力，因为这些机构拥有良好的声誉并提供在其市场中可能是独一无二的专业服务。
Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power. This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care. High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins. Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U. S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates. Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.